Provider Demographics
NPI:1528086188
Name:NOYES, JOHN DAVID JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:NOYES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 98TH ST NW STE C3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-9021
Mailing Address - Country:US
Mailing Address - Phone:505-352-5439
Mailing Address - Fax:
Practice Address - Street 1:120 98TH ST NW STE C3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-9021
Practice Address - Country:US
Practice Address - Phone:510-701-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51004844Medicaid
NM1768244OtherUNITED CONCORDIA GROUP #